Insurance policy owners must understand that not all companies are out to represent their best interests.
A person purchases disability insurance hoping they won’t need it. At the same time, they must get compensated when the need arises.
Unfortunately, not all disability claims are without snags. Insurance companies such as The Hartford and Unum, alongside other smaller firms, may deny your claim or question your eligibility for disability benefits for many reasons.
In these instances, you need to prove your disability by launching an appeal, which can be highly stressful and challenging, especially without the help of a seasoned attorney. In this article, you’ll discover how to build a solid case to overturn a disability claim rejection.
Reasons Why Insurance Companies May Reject Your Disability Claim
The Hartford Insurance is part of the Hartford Financial Service Group, Inc., which prides itself as a Fortune 150 company with over USD$ 70.82 billion worth of assets as of 2019. Despite being one of the most reliable companies around, it’s not uncommon for this company to delay, reject, and terminate claims.
As such, some policy owners have either launched an appeal or decided to sue Hartford for wrongful denial of benefits. Other companies suffer the same fate, with the Unum Suit and similar petitions. Before filing a complaint or launching an appeal, it’s crucial to know the reasons why a claim might be denied:
- You don’t (or no longer) fit their definition of a ‘person with a disability:’ Before taking out an insurance policy, it’s paramount that a person studies all the terms and conditions, especially the company’s definition of ‘disability.’
- Missing documents lacking evidence: Besides medical records, companies may ask for further evidence and forms to give ‘more meat’ to your claim.
- You didn’t pass their evaluation and surveillance process: Insurance companies like Hartford will investigate to validate a claim. They’ll do this by hiring a private investigator or checking your social media accounts for posts that refute your disability claim. The company may also hire their medical specialists to evaluate your case.
How to File an Appeal
Because disability policies vary, it’s crucial to read and understand the insurance company’s denial letter. Take this and your insurance policy for instructions on contesting the denial of your claim. The issues must be settled internally first before taking your insurer to court.
If the company decides to uphold their decision, here’ what you should do:
- Hire a Skilled Attorney
If your rejection is caused by insufficient evidence, consider submitting the additional medical records and physician statements, among other additional documents required by the company. It’s time to hire the services of a legal professional.
An experienced legal counsel will help you interpret the denial letter and analyze the terms in your long-term disability policy. This can help you gather enough evidence to strengthen your appeal strategy.
- Get a Copy of Your Claim File
You and your lawyer should formally request a copy of your claim file. Per federal laws, your insurer must provide you with this set of documents containing everything the company has done to evaluate your claim. The file should include the exchange of communication with doctors who reviewed your case.
Check the file to see whether all your medical records have been considered and assessed appropriately. Your legal team may ask questions about how your claim is handled in an appeal. To this end, they can ask for the company’s relationships with third-party doctors, how many shares they’ve reviewed, approved, and rejected for the year. The team can also look at other potential loopholes, such as conflict of interest. Your lawyer can help you gather thorough and accurate evidence so Hartford or any other insurer can’t find any loopholes in your appeal.
- Obtain Additional Medical Evidence
In addition to complying with the deficiencies as pointed out by the company’s rejection letter, it’s crucial to ask for relevant medical support to boost your claim. Getting multiple medical opinions and evaluations on your claim strengthens the impact of merely submitting medical records and your attending physician’s notes.
Your legal counsel should have a battery of doctors to look at the file and request for new or additional tests, if possible. Take your attending physician on board to review the case and respond to the doctors hired by the insurance company. Being as detailed as possible can also be highly beneficial to your appeal.
Besides medical professionals, your legal team may also cite medical literature that expounds on the impacts of your disabilities and collect statements from co-workers, family members, and friends. Most importantly, do these things as soon as possible, as a Hartford denial of your appeal is likely if you fail to submit additional evidence on time.
The Bottom Line
Insurance policy owners must understand that not all companies are out to represent their best interests. Before filing a claim, they should review and understand the terms and conditions of their policy and expect a slight chance of getting denied.
If their application gets rejected, claimants must hire a lawyer to launch an appeal. With the help of legal counsel, a claimant can collect overwhelming evidence, such as the points discussed earlier, that will leave no room for insurance companies to find fault in.
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